| NPI | 1992126924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2014023811) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: LA 1248) |
| Enumeration Date | 2013-12-17 |
| Last Update Date | 2023-06-01 |